Narrative perspective, person references, and evidentiality in clinical incident reports

Chrystie Myketiak,Shauna Concannon,Paul Curzon

doi:10.1016/j.pragma.2017.06.018

Abstract

Clinical incident reporting provides opportunities for organisational learning, ideally leading to improved patient safety. However, this process requires healthcare professionals to record experiences where patients were harmed, or had the potential to be harmed. It also requires others to interpret the language used in order to make recommendations. We investigate the use of epistemic and evidential markers in incidents labelled as ‘user error’, in which a responsible individual is categorically implied, as opposed to other types of incidents where responsible individuals may not be tacitly assumed, such as ‘failure of sterilisation or contamination of equipment’ and ‘lack of suitably trained staff’. By analysing the frequency of various linguistic features related to authority and accountability, we provide insights into the pragmatics of clinical incident reporting. We find that user error reports differ from other categories of reports in that the identity of the narrator is obscured and the locus of agency is removed, and that this difference is irrespective to levels of patient harm. User error reports differ from other incident reports in the following statistically significant ways: they are more likely to be written using impersonal absent narration and feature significantly higher frequencies of epistemic markers of uncertainty and evidentiality.

Highlights

Clinical incident reports are one tool used to support learning from events in medical practice where patients are harmed or potentially harmed
Our findings demonstrate that there is a significant statistical difference between the narrative perspective used in clinical incident reports that have been classified as ‘user error related’, and those in the Baseline Corpus
Can verify, that despite being counter-intuitive, when considering implications of reporting errors in an organisational setting where employees may report to researchers that they are careful with the language they use on incident reports due to concerns of repercussions, legal liability regarding the incident (Gallagher et al, 2003), narrative viewpoint is not affected by level of harm; user error incidents in our corpus are more likely to be rated as ‘no harm’ (83.09% in the User Error Corpus compared with 74.09% in the Baseline)

Summary

Introduction

Clinical incident reports are one tool used to support learning from events in medical practice where patients are harmed or potentially harmed. Healthcare professionals are encouraged to report clinical incidents, including near misses, there is widespread underreporting of patient safety incidents in both the UK and the USA (Cousins et al, 2012; Wagner et al, 2013; Waring, 2005). In 2010, the UK's National Patient Safety Agency (NPSA) attempted to address this by making it mandatory for National Health Service (NHS) trusts in England and Wales to report all incidents involving severe harm or death to the National Records and Learning System (NRLS), reporting of incidents resulting in no, low or moderate patient harm remained voluntary (Donaldson et al, 2014). Myketiak et al / Journal of Pragmatics 117 (2017) 139--154

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Results

Discussion

Conclusion